Relapse: A Normal Part of Recovery?
“Relapse: a normal part of recovery,” or so I have been told. As a clinician, patients’ relapses have been the most challenging part of working within the field of chemical dependency. While there are endless resources to learn and understand the disease of addiction, nothing quite compares to the feeling in the pit of my stomach when I hear of someone’s relapse. This feeling reminds me of the devastating consequences addiction has had on my patients, their families, and, to be quite honest, on myself. I am fascinated with how addiction can seemingly take over someone’s mind. We can easily learn about the biological reasons for an individual’s cravings and addiction, but addiction is more than a medical disease, as it encompasses body, mind, and spirit.
Street chemists
Throughout history, mind-altering substances have been a part of various societies across a range of diverse cultures and even religious groups. Governments have raced to keep up with drug regulations as “street chemists” are always coming out with new substances to alter one’s perception of the world, oneself, and others. The most recent phenomenon of drugs to sweep across the United States and Europe is the synthetic drugs. Synthetic cannabinoids, commonly referred to as spice, became widely available to the American people in the mid-2000s. Synthetic cannabinoids were initially being tested in laboratories as new therapeutic agents for pain and to stimulate appetite. However, it was quickly noted that these substances mimicked the impact of a THTHC intoxication active ingredient in “traditional” marijuana. The binding affinity of synthetic cannabinoids is up to five times more efficacious than THC.
Since spice is a relatively new drug, the research is very limited. In the available literature, the use of spice has been associated with psychosis, agitation, nausea, vomiting, seizures, dilated pupils, and somnolence. Cardiovascular effects have also been evident, such as tachycardia and tachyarrhythmias.
Case reports document that the “high” from smoking spice lasts anywhere from one to six hours. The range of variability is a result of the numerous different brands and different blends of ingredients in synthetic cannabis. A quick internet search revealed that at least 25 different brands of spice currently exist on the market.
Federal and local governments
Federal and local governments have attempted to regulate spice use by outlawing the active ingredients in spice. However, street chemists continually alter the active ingredients to avoid regulations and make them virtually undetectable on regular toxicology screens. Furthermore, spice is packaged as “incense” and states on the packaging, “not for human consumption.” As a result, spice has been easy to obtain, as it has been available at various gas stations and convenience stores. In 2012, the Florida legislation proposed a bill to classify synthetic cannabinoids as a “Schedule I” hallucinogen. The proposed legislation was signed into law by the Florida governor, and now the “sale, possession, manufacturing, or delivery of synthetic cannabinoids” is a third-degree felony. Possession of less than 2 grams remains a first-degree misdemeanor.
Despite the challenges of working in this field, working in the addiction field helps me to stay grounded and reminds me to stay “present-focused” as I repeat in my mind “just for today.”